NPI | 1801122197 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ID D-5005-PE) |
Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 25007) |
Enumeration Date | 2009-10-21 |
Last Update Date | 2020-05-20 |